Nonpenetrating Deep Sclerectomy For Glaucoma After Descemet Stripping Automated Endothelial Keratoplasty: Three Consecutive Case Reports

The purpose of this study was to evaluate the efficacy and safety of nonpenetrating deep sclerectomy (NPDS) in 3 consecutive eyes with preexisting and uncontrolled glaucoma after Descemet stripping with automated endothelial keratoplasty (DSAEK). NPDS with intrascleral implant and topical adjunctive intraoperative mitomycin C (0.2 mg/mL 1 minute) was performed. Intraocular pressure (IOP) and number of glaucoma medication were registered before and after NPDS with at least 1-year follow-up. Intraoperative and postoperative complications were also registered. Before NPDS, IOP was 18 mm Hg in 1 patient and 32 mm Hg in the other 2 patients. Four antiglaucoma drugs were used in 2 cases and 3 in the other one. At 1 year after NPDS, all the patients had an IOP ≤18 mm Hg. Two patients required postoperative antiglaucoma medications (1 drug in 1 case and 2 drugs in the other one). Neodymium-doped yttrium aluminum garnet laser goniopuncture was needed in 2 patients and it had to be repeated in 1 of them. No complications related to NPDS were observed. A corneal graft rejection was observed 5 months after NPDS in 1 case that resolved without sequelae with intensive corticosteroid eye-drop therapy. NPDS could be a safe and successful alternative to conventional filtration surgery after DSAEK in eyes with uncontrolled glaucoma. Larger series and a longer follow-up would be necessary to set the actual role of surgery in DSAEK patients.